Trial reportArchives of internal medicine2010
Getting to "no": strategies primary care physicians use to deny patient requests.
Trial report in Archives of internal medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed.
- Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids.Pain medicine (Malden, Mass.) · 2016Trial
- Deflecting Before Prescribing: Negotiating About Opioids and Chronic Pain in Primary Care.Health communication · 2026Article
- Challenging Encounters: A Systematic Scoping Review to Understand Patients' Influence on GPs' Compliance With Imaging Guidelines.Journal of evaluation in clinical practice · 2026Article
- On Patient Safety: It Is Time to Rethink Gabapentin.Clinical orthopaedics and related research · 2025Article
- Primary care physician responses to requests by older adults for unnecessary drugs: a qualitative study.BMC primary care · 2022Article
- GP strategies to avoid imaging overuse. A qualitative study in Norwegian general practice.Scandinavian journal of primary health care · 2022Article
- Conditions for gatekeeping when GPs consider patient requests unreasonable: a focus group study.Family practice · 2022Article
- Association of Low-Value Care Exposure With Health Care Experience Ratings Among Patient Panels.JAMA internal medicine · 2021Article
- Patient Requests for Tests and Treatments Impact Physician Management of Hypothyroidism.Thyroid : official journal of the American Thyroid Association · 2019Article
- Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.International journal of general medicine · 2018Article
- What happens when the doctor denies a patient's request? A qualitative interview study among general practitioners in Norway.Scandinavian journal of primary health care · 2017Article
- Nurse Practitioners' Use of Communication Techniques: Results of a Maryland Oral Health Literacy Survey.PloS one · 2016Article
- Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis.The Permanente journal · 2016Article
- [Theory of action on patient relationships. A different way of representing and understanding the behaviour of the family doctor in the clinic].Atencion primaria · 2015Article
- Integrative medicine is integral to providing patient-centered care.Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2015Article
- Should health care providers be accountable for patients' care experiences?Journal of general internal medicine · 2015Review
- Impact of patient requests on provider-perceived visit difficulty in primary care.Journal of general internal medicine · 2015Observational
- Identifying competencies required for medication prescribing for general practice residents: a nominal group technique study.BMC family practice · 2014Article
- Ethical and epistemic issues in direct-to-consumer drug advertising: where is patient agency?Medicine, health care, and philosophy · 2013Article
- Media, messages, and medication: strategies to reconcile what patients hear, what they want, and what they need from medications.BMC medical informatics and decision making · 2013Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
backgroundPhysicians need strategies for addressing patient requests for medically inappropriate tests and treatments. We examined communication processes that physicians use to deal with patient requests of questionable appropriateness.
methodsData come from audio-recorded visits and postvisit questionnaires of standardized patient visits to primary care offices in Sacramento and San Francisco, California, and Rochester, New York, from May 2003 to May 2004. Investigators performed an iterative review of visit transcripts in which patients requested, but did not receive, an antidepressant prescription. Measurements include qualitative analysis of strategies for communicating request denial. The relationship between strategies and satisfaction reports in postvisit questionnaires was examined using the Fisher exact test.
resultsStandardized patients requested antidepressants in 199 visits; the antidepressants were not prescribed in 88 visits (44%), 84 of which were available for analysis. In 53 of 84 visits (63%), physicians used 1 or more of the following 3 strategies that explicitly incorporated the patient perspective: (1) exploring the context of the request, (2) referring to a mental health professional, and (3) offering an alternative diagnosis. Twenty-six visits (31%) involved emphasis on biomedical approaches: prescribing a sleep aid or ordering a diagnostic workup. In 5 visits (6%), physicians rejected the request outright. Standardized patients reported significantly higher visit satisfaction when approaches relying on the patient perspective were used to deny the request (P = .001).
conclusionsStrategies for saying no may be used to communicate appropriate care plans, to reduce provision of medically inappropriate services, and to preserve the physician-patient relationship. These findings should be considered in the context of physician education and training in light of increasing health care costs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.